Dental arch changes after anterior open bite treatment in the mixed dentition produced by miniscrew-supported palatal crib vs conventional fixed palatal crib:: A randomized clinical trial

ObjectivesTo evaluate the dental arch changes produced by the miniscrew-supported palatal crib (MSPC) and the conventional fixed palatal crib (CFPC) after the treatment of patients with anterior open bite (AOB) attributed to the tongue-thrusting habit in the mixed dentition stage.Materials and MethodsA total of 26 children aged 8 to 11 years with an AOB were randomly distributed into two equal groups; the MSPC group was treated using a palatal crib supported by two miniscrews inserted paramedially, whereas the CFPC group was treated using a conventional fixed palatal crib soldered to bands. Digital models were obtained pretreatment and after a follow-up duration of 9 months.ResultsThe MSPC group included 12 participants (9 girls and 3 boys; mean age, 9.4 ± 0.75 years), and the CFPC group included 12 participants (10 girls and 2 boys; mean age, 9.0 ± 0.73 years). The amount of AOB closure was similar in both groups: 3.97 ± 1.44 mm in the MSPC group and 3.97 ± 0.89 mm in the CFPC group. There was significant mesial movement of the maxillary first molar in the CFPC (−1.42 ± 0.99 mm) compared with the MSPC group (−0.53 ± 0.32 mm).ConclusionsBoth appliances resulted in similar improvement in the amount of AOB closure. There was significantly more mesial movement of the maxillary first molars in the CFPC group compared with the MSPC group.     

A bite by the Twin-Barred Tree Snake,Chrysopelea pelias (Linnaeus, 1758)

Introduction.?The Twin-Barred Tree Snake, Chrysopelea pelias, is a colubrine that, like other members of the genus Chrysopelea, is able to glide in the arboreal strata. Little is known about the effects of its bite. This report is the first clinically documented bite by this relatively uncommon rear-fanged species.?Case report.?The patient was a 19-year-old female who arrived at the Emergency Department (ED) of an urban teaching hospital 6 h after being bitten by a snake that was later provisionally identified as a C. pelias. Noted on presentation were bite marks on the right middle toe with minimal inflammation and tenderness. There was slight numbness over the dorsum of the right foot and discomforting sensation radiating up the thigh that persisted for several days. There was mild pyrexia, but no evidence of any systemic effects. The full blood count did show neutrophil leucocytosis, and transient hemoglobinuria was noted in an initial urine analysis. Discussion?.?The properties of Duvernoy's secretion of C. pelias remain uncharacterized. In this case, the clinical course featured only the local effects noted above. However, the significant local pain reported by the patient suggests that bites by C. pelias are not necessarily trivial and do require full evaluation and observation in a medical facility. Discussed also is the importance of the establishment of a national registry for animal bites and stings in Malaysia.?Conclusion.?Such a facility could expedite safe and appropriate management of envenomed patients.     

侧卧位徒手气道开放置胃管法在重症脑卒中患者的应用

目的探讨适用于重症急性脑卒中昏迷伴舌后坠、颅内压增高患者的胃管置入方法。方法将90例重症急性脑卒中昏迷患者分为3组各30例,观察组采用侧卧位徒手开放气道法,对照1组采用侧卧位置管法,对照2组采用侧卧位拉舌法,比较3组患者1次置管成功情况、不良反应程度和舌损伤情况。结果1次置管成功率,观察组高于对照1组（P<0.01）,与对照2组比较差异无统计学意义（P>0.05）;不良反应程度,观察组低于对照2组（P<0.01）,与对照1组比较差异无统计学意义（P>0.05）;舌损伤情况,观察组低于对照2组（P<0.05）,与对照1组比较差异无统计学意义（P>0.05）。结论侧卧位徒手气道开放置胃管法,用于重症脑卒中昏迷伴舌后坠、颅内压增高患者,成功率高、刺激小、损伤轻,值得临床推广。     

毒蛇咬伤治疗前后肾功能变化规律的探讨

目的：探讨各种毒蛇咬伤患者治疗前后肾功能的变化情况。方法选择近两年住院治疗、属于何种蛇伤诊断明确的毒蛇咬伤患者作为研究对象,这些患者在治疗前后各时段均进行5项肾功能指标检测,按蛇种、时段及病情对检测结果作出统计分析。结果与治疗前比较,各种毒蛇咬伤在治疗后1d除个别指标外其检测均值都有不同程度地升高趋势、特别是治疗后2d升高更明显,有些指标的升高具有显著性差异（ P＜0．05或P＜0．01）。与治疗后2 d比较,治疗后4 d各项指标均有不同程度下降。治疗前后各时段除尿酸外,其它指标均值基本上是蝰蛇咬伤显著高于银环蛇咬伤、竹叶青蛇咬伤、眼镜蛇咬伤和眼镜王蛇咬伤（P＜0．05或P＜0．01）。结论5种毒蛇咬伤均可能导致肾功能损害,其损害程度以眼镜王蛇咬伤最轻,蝰蛇咬伤最重。     

吕华运用开泄法治疗慢性阻塞性肺疾病急性加重期经验

吕华认为慢性阻塞性肺疾病(COPD)急性加重期以痰阻气壅、肺气不宣,久则脾肾气虚、虚气上逆为基本病机,善于运用开泄法,以升降散为基础方,配合健脾益肾、活血化瘀法,具有宣展肺气、通络祛瘀、畅达痰邪、通利三焦气机之功效,取得了较好的临床疗效。     

蛇伤散外敷联合艾灸治疗五步蛇咬伤的临床观察与护理

目的 探讨蛇伤散外敷联合艾灸治疗五步蛇咬伤的临床效果。方法 选取本院2018年3月～2019年9月门诊患者117例,随机分为观察组59例和对照组58例。对照组给予抗五步蛇毒血清、抗破伤风、糖皮质激素、对症处理、局部处理等西医常规治疗,并给予护理配合;观察组在常规西医治疗与护理配合基础上,咬伤局部给予蛇伤散外敷,并施以八风、八邪灸疗。治疗结束后,进行疗效评价,并观察其他指标,包括消肿时间、止痛时间、臂围差值及住院时间。结果 观察组、对照组治愈率分别为76.3%、56.9%,两组总体疗效经秩和检验,差异有统计学意义(P0.05)。观察组、对照组止痛时间分别为(6.3±1.4) h、(11.8±2.9) h,与对照组比较,观察组明显缩短(P0.05);观察组、对照组消肿时间分别为(97.3±5.8)h、(152.5±37.2) h,与对照组比较,观察组明显缩短(P0.05);观察组治疗前后臂围差值为(5.9±1.1)cm,对照组为(2.5±0.6)cm,与对照组比较,观察组臂围明显减小(P0.05);观察组、对照组住院时间分别为(3.9±0.9)d、(5.5±1.2)d,与对照组比较,观察组时间明显缩短(P0.05)。结论 蛇伤散外敷联合艾灸治疗五步蛇咬伤在临床疗效、消肿止痛等方面均有效,值得进一步推广应用。     

Posterior scoliosis correction for adolescent idiopathic scoliosis using side-opening pedicle screw-rod system utilizing the axial translation technique

Background:

Though adequate literature is present depicting the results of pedicle screw-rod instrumentation using top loading systems for correction of adolescent idiopathic scoliosis (AIS), using the rod rotation technique, few published data is available regarding side loading systems used for a similar purpose. We report a retrospective study of a cohort of patients with strict inclusion criteria who underwent surgical correction of AIS with side-opening pedicle screw-rod posterior instrumentation using the axial translation technique of curve correction to assess the efficacy of side opening system for scoliosis correction with regards to patient satisfaction, Cobb''s angle correction and spinal balance.

Materials and Methods:

Clinical and radiological outcomes were measured in 14 consecutive patients (3 males, 11 females) with an average age of 14.0 years (range 9 to 23 years). They were followed up for an average period of 13.0 months (range – 2.2 to 28.5). All patients underwent posterior instrumentation only with pedicle screws used as anchor points. Hybrid constructs using hooks/wires or curves requiring anterior release were excluded from the study. All levels were not instrumented – more screws were put on the concavity and in the peri-apical region. Radiological evaluation was done by whole spine standing AP, lateral radiograms preoperatively and 1, 3, 6 and12 months after surgery. Cobb''s angles were measured and the spinal balance was noted. Clinical evaluation was done by SRS questionnaire. The complications were documented.

Results:

The mean preoperative Cobb''s angle was 58.35° (range – 44 to 72°), which came down postoperatively to 23.45° (range – 10 to 38°) signifying a mean correction of 59.57% (range – 26.92 to 76.17%). Clinical outcomes were evaluated using the SRS – 30 questionnaires. The values of mean pre- and postoperative scores are 3.68 and 4.18, showing an improvement of 0.5 points. Other than one patient of superficial wound infection, which healed with antibiotics, there was no major complication. No patient had neurological deterioration.

Conclusion:

Side-opening spinal instrumentation systems, using the axial translation technique, achieved good clinical and radiological outcome for patients of AIS.     

Lemierre's syndrome

Lemierre's syndrome is a rare disease, mostly affecting young adults in good health, which can lead to significant morbidity and mortality. We report one case with favourable outcome and clinical features stereotypics: angina, septic thrombosis of the internal jugular vein, pulmonary septic metastasis, Fusobacterium necrophorum on blood cultures. Antibiotic therapy targeting anaerobes has been rapidly initiated and maintained 4-6 weeks. The anticoagulation has been maintained 4 weeks.     

腹腔开放患者的肠内营养支持

目的观察腹腔开放患者能否安全有效地应用肠内营养（EN）。方法回顾近3年因腹腔间室综合征行腹腔开放的患者的临床资料。通过空肠行EN支持超过3d者入选。所有患者腹腔敞开后均以聚丙烯网覆盖,根据肠功能恢复情况,决定EN开始时机和方案。采用输注泵连续输注,分别于EN前和结束时检测血浆蛋白水平和氮平衡。使用Harris—Benedict方程式计算或间接能量测定仪测定实际能量消耗和呼吸商。结果21例患者EN实施时间平均（51．5±33．6）d,开始于腹腔开放后（8．8±5．5）d,达到目标值的93％～95％。治疗前血各项蛋白水平低于正常值,但经过EN支持后均有改善,其中纤维连接蛋白增加明显,相关并发症未有增加。结论腹腔开放患者肠管虽外露,但在感染得到控制,外加聚丙烯网的覆盖情况下,及时给予EN,肠黏膜和肠壁组织获得营养和循环改善．使组织修复功能趋向健康。EN可以安全有效地应用于腹腔开放的患者。     

胰管开口炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗

目的 探讨胰管开口部位炎性病变导致的慢性阻塞性胰腺炎的诊断和外科治疗方式.方法 对我院自2002年1月至2010年11月收治的28例慢性阻塞性胰腺炎患者的临床资料进行回顾性总结.其中13例患者血清淀粉酶和脂肪酶升高伴有反复急性腹痛,经影像学检查显示胰管全程扩张改变,外科探查明确诊断为胰管开口部位炎性病变导致的慢性阻塞性胰腺炎.对此13例患者的临床表现、诊断方法、手术探查发现和治疗方法进行分析,并对术后的状况包括疼痛复发、生活质量、胰腺的影像学变化和血清胰腺酶学进行随访观察.结果 13例患者均具有典型的慢性阻塞性胰腺炎的临床表现,但12例患者的影像学表现有别于十二指肠乳突、壶腹或胰腺导管内肿瘤导致的慢性阻塞性胰腺炎的图像特征,手术探查和影像学揭示多数患者的胆胰共同通道过短或存在胰腺分裂畸形,对12例患者实施十二指肠乳突、壶腹及胰管开口切开成形术或副乳突切开成形术,术后随访结果显示均未再伴有胰腺酶学升高的急性腹痛发作.结论 以胰管扩张为主而不伴有胆管慢性梗阻是胰管开口炎性病变导致的慢性阻塞性胰腺炎的影像学特征,十二指肠乳突炎症或副乳突炎症时容易在过短的胆胰共同通道或胰腺分裂畸形的患者中引发胰管开口的狭窄而发生慢性阻塞性胰腺炎,纠正胰管开口狭窄、改善胰管引流的局部成形术是简单、有效的治疗方法.